Healthcare Provider Details

I. General information

NPI: 1184590796
Provider Name (Legal Business Name): SAIL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 S EASTERN AVE # 6-266
LAS VEGAS NV
89119-5486
US

IV. Provider business mailing address

4225 S EASTERN AVE # 6-266
LAS VEGAS NV
89119-5486
US

V. Phone/Fax

Practice location:
  • Phone: 702-218-7484
  • Fax:
Mailing address:
  • Phone: 702-218-7484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. ANTOINETTE MARIE HORRISLAND
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MS.CCC-SLP
Phone: 702-218-7484